Joint Faculty of Intensive Care MedicineJFICM Medal:Dr Felicity Helen HawkerThe award of the JFICM Medal to FelicityHelen Hawker, presented at the <strong>2009</strong>Annual Scientific Meeting.The Joint Faculty of Intensive Care MedicineMedal was established in 2005 <strong>and</strong> wasfirst presented at the inaugural JFICMAnnual Scientific Meeting that year. Thesole criterion for its award being that therecipient has made an outst<strong>and</strong>ing <strong>and</strong>major contribution to the specialty. It isthus very fitting that Felicity Helen Hawkeris to receive the JFICM Medal at the last ASMof JFICM. Fitting because of her enormous<strong>and</strong> continuing contribution, fitting becauseof the unique nature of that contribution<strong>and</strong> also that she was the first Dean of theJoint Faculty.Like many famous <strong>Australian</strong>s she wasborn in Tasmania <strong>and</strong> it was apparent fromher university <strong>and</strong> school days that she wasgoing to make a mark on the world. Ourspecialty is very fortunate that she choseintensive care medicine <strong>and</strong> she chose tolead <strong>and</strong> help guide the development ofour specialty. She was dux of her school<strong>and</strong> first in her year at the University ofTasmania, <strong>and</strong> a champion horsewoman<strong>and</strong> winner of many academic <strong>and</strong>sports prizes.After completing her universitydegree, she gained diverse anaesthesia<strong>and</strong> intensive care training in Hobart,Melbourne, Glasgow <strong>and</strong> Sydney, gainingEnglish <strong>and</strong> <strong>Australian</strong> fellowships beforetaking up a position at Royal PrinceAlfred Hospital in Sydney as an intensivecare specialist. There she was known forher clinical skills, academic ability <strong>and</strong>consideration of patients, families <strong>and</strong> allmembers of the ICU team.After 10 years as co-director of ICU atRPA, she moved to Melbourne in 1995to become the director of ICU at CabriniHospital, perhaps somehow related to herblossoming relationship with a Melbournesurgeon, whom she later wed <strong>and</strong> whosecareer has many parallels with hers. Theyhave a son Paul, an extended family <strong>and</strong>very full lives in <strong>and</strong> out of medicine.It is difficult to do justice to Felicity’sextensive career achievements, <strong>and</strong> 20-pageCV, in several short paragraphs becauseFelicity has contributed at every level ofintensive care education <strong>and</strong> training fromsupervisor of training, regional educationofficer; too many committees to list, boards<strong>and</strong> executives, the panel of examiners,education officer, Censor, Vice-Dean, Dean<strong>and</strong> now director of Professional Affairs.She was the last dean of the Faculty ofIntensive Care <strong>and</strong> the first dean of thejoint faculty, having been instrumental inbringing together the two intensive caretraining programs. In essence she has led<strong>and</strong> contributed to more than 15 different,major appointments over 20 years, not onlyin the section of intensive care, FIC<strong>ANZCA</strong>,JFICIM <strong>and</strong> ANZICS but also <strong>ANZCA</strong> <strong>and</strong>FRACP <strong>and</strong> the Committee of Presidents ofMedical <strong>College</strong>s. For eight years she wasa council member of the Western PacificAssociation of Critical Care Medicine.During her leisure time she has editedfour publications, given more than 35invited plenary lectures, written herown classic textbook <strong>and</strong> 21 chapters ofother books as well as numerous originalscientific articles, while following her loveof horses <strong>and</strong> bringing up a family.It is apparent that Felicity has not onlyaffected the lives of many through herclinical skills <strong>and</strong> caring, but her intellect,wise counsel <strong>and</strong> capacious memory fordetail have helped to guide our professionin its growth towards an independentcollege. She has done this with humanity<strong>and</strong> humility <strong>and</strong> her very humannesshas been a beacon for trainees,particularly women.A few years ago S<strong>and</strong>y Peake quotedone of the pioneers of ICM, Matt Spence,when he said that the success of intensivecare was dependent on a dedicated team ofyoung doctors, who should be “young men,physically able to cope with emergenciesat any time <strong>and</strong> for prolonged periods”.Matt’s model has proven to be outdated<strong>and</strong> it is such women as Felicity <strong>and</strong> S<strong>and</strong>ywho have helped our specialty into the21st century. Hopefully work practices arebecoming more balanced <strong>and</strong> opportunitiesare available for all to achieve leadership<strong>and</strong> academic success. This is no smallpart due to Felicity’s advocacy for aflexible training scheme that gives fairopportunities for women.Felicity has been a great role model<strong>and</strong> many a time I have used Felicityas an example to female trainees ofthe accomplishments, enjoyment <strong>and</strong>satisfaction that can be gained from ICUpractice. She has devoted a large part ofher very busy life to sustain <strong>and</strong> grow ourspecialty, its training program <strong>and</strong> presencein the region. She has been at the forefront,caring, transforming the profession <strong>and</strong>taking the lead. She is an inspiration toall <strong>and</strong> a very worthy recipient of theJFICM Medal.Clinical A/Prof Richard LeeJoint Faculty of Intensive Care MedicineBoard Member80The <strong>ANZCA</strong> <strong>Bulletin</strong> <strong>June</strong> <strong>2009</strong>
Joint Faculty of Intensive Care MedicineThe future of intensivecare medicineThis is an edited extract of the JFICMGraduation Ceremony Oration “TheFuture of Intensive Care Medicine inAustralia <strong>and</strong> <strong>New</strong> Zeal<strong>and</strong>” by Dr CaroleFoot, staff intensive care specialist,Royal North Shore Hospital.What does the future hold for intensivecare medicine? I’m going to focus on whatI see as the three most important<strong>and</strong> interlinked areas: technologicaldevelopments that will influence how wepractice, the nature of critically ill patients<strong>and</strong> the implications for the intensivecare workforce.TechnologyICU environmentWhat will our ICUs look like in theyears to come? We are already seeing theresults of exciting major design changes.For patients, more comfortable <strong>and</strong>pressure-easing beds that enable easypositional changes are entering the market.Access to natural light that facilitatesrestoration of circadian rhythms, a trendtowards single rooms that offer greaterprivacy <strong>and</strong> reduced risks of cross-infection,noise-reducing <strong>and</strong> mood- enhancingdecors, personal entertainment systems<strong>and</strong> more comfortable facilities for relativesare some of the staples of new ICUs.Wireless technology is exp<strong>and</strong>ing <strong>and</strong>I think the spaghetti-like tangle of cablesfrom patients monitoring systems willsoon become a thing of the past. Advancedcomputer networking with more powerfulplatforms <strong>and</strong> improved user interfaces,offer the promise of more efficientmonitoring <strong>and</strong> record keeping,decision support <strong>and</strong> availabilityof reference materials.ResearchI am hopeful that basic scientists willhelp us underst<strong>and</strong> <strong>and</strong> potentiallymanipulate cellular systems that influencesurvival <strong>and</strong> assist in prognostication.It will become clearer why some patientsappear remarkably resistant to criticalillness <strong>and</strong> yet others equally fragile.We are already starting to underst<strong>and</strong>some of the genetic polymorphismsthat control the inflammatory responseinfluencing the outcome of septic shock<strong>and</strong> ARDS.<strong>New</strong> drugs <strong>and</strong> equipment will come<strong>and</strong> go. We must continue to ensurethat they are evaluated in an ethical <strong>and</strong>scientifically robust manner that can bebest achieved by being part of the process.We must inspire, mentor <strong>and</strong> supporta generation of ICU basic <strong>and</strong> clinicalresearchers who will push the envelopeof our knowledge. This will not be easy asscarce resources are stretched, but creativeways of funding this must be pursued.Co-operative relationships that cross theborders of institutions, specialties <strong>and</strong>disciplines will foster synergism <strong>and</strong>efficiency that isolated silos cannot achieve.TeachingAs multimedia technology changes ourdaily lives, the opportunity to blend new,sophisticated learning platforms withtraditional medical educational pedagogyis truly electrifying.Borrowing from aviation, medicalsimulation is here to stay. Its role is beingincreasingly defined as evidence mountsthat it is a reliable <strong>and</strong> well-receivedmethod of teaching <strong>and</strong> assessing technicalskills, as well as team crisis management.I feel extremely strongly that we must notunderestimate our common sense whenevaluating how to incorporate simulationinto our ICU training programs. Practice canmake perfect, patients should not be guineapigs <strong>and</strong> doctors <strong>and</strong> nurses who worktogether every day should train together. Inthe future the insights <strong>and</strong> underst<strong>and</strong>ingthat this will bring will make us moreeffective as well as cohesive.Screen-based simulation is only inits infancy but is likely to come into itsown over the coming years as computerpower <strong>and</strong> b<strong>and</strong>width exp<strong>and</strong>s. Virtualworlds such as “Second Life” are beingincorporated into university teaching forother disciplines <strong>and</strong> healthcare is catchingup. Second Life is a 3D on-line environmentwhere users can socialize, connect, explore,learn <strong>and</strong> create using voice <strong>and</strong> text chat.There have never been so many methodsavailable for communicating informationto our trainees <strong>and</strong> with each other.Social networking sites such as Facebook,Podcasts, Blogs <strong>and</strong> Wikis are the preferredmedium for exchanging information for anincreasing number of people.These new developments are a challengefor older clinicians who did not grow upwith <strong>and</strong> become comfortable with thesemodalities. I am one of these. I am an adultof the email generation <strong>and</strong> student of thetextbook <strong>and</strong> yet I feel strongly that failureto embrace these new technologies risksopening up a communication chasm <strong>and</strong>missed opportunities. Although there aremany unanswered questions, includinghow to control the quality of informationexploding in the virtual world, I feelstrongly that we must not be neo-luddites- resistors of new technology!PatientsThe wave of obesity sweeping westerncountries is no small matter! Australia isnow the fattest nation in the world. Weare already seeing the consequences ofthis problem in our ICUs, with the needfor bariatric equipment <strong>and</strong> increasingadmissions of morbidly obese adults.This trend is predicted to increase overthe coming years.Competing for these beds is a waveof elderly patients. Like many countries,the <strong>Australian</strong> population is ageing as aresult of unprecedented improvementsin healthcare. The ANZICS database tellsus that the number of intensive care daysprovided to patients over 70 has beenincreasing by around 14% per annum. Thisis not surprising as over the last decadepapers reporting excellent ICU outcomescan be found for older patients with a rangeof admission diagnoses <strong>and</strong> organ failures.Addressing the difficulties of ICU triage,particularly for chronically ill <strong>and</strong> elderlypatients, is beyond the scope of this talk.I strongly believe, however, that regardlessof clarifying the best c<strong>and</strong>idates for ourcare, the pressure on hospital <strong>and</strong> ICUbeds will only increase <strong>and</strong> resources arealready stretched.Our emergency medicine colleaguesconstantly struggle with access block <strong>and</strong>ambulance ramping on a daily basis <strong>and</strong> inthe ICU I am starting to see exit block, wherethe hospital is so full that ICU patients nolonger needing our care remain in our unit.As an example of this I recently worked withan endocrinologist in managing a younggirl with her first diagnosis of DKA fromadmission right through to discharge homefrom our ICU. The situation is exacerbatedThe <strong>ANZCA</strong> <strong>Bulletin</strong> <strong>June</strong> <strong>2009</strong> 81